Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 3688T | TX |
NPI | 1003976952 |
---|---|
Provider Name | Dr. Ronald K Smith |
First Address | Mesquite, TX 75149-6000 |
Second Address | Mesquite, TX 75149-6000 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/12/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U06299 | (02) | TX |